Evaluación clinicorradiológica en hemiartroplastia de hombro

Resultados La prevalencia de la patología quirúrgica fue del 0,4% del total de primeras consultas ortopédicas de primera vez, la edad promedio fue de 61,7 ± 12,49 años (rango: 32-85 años); sexo masculino, 8,6%, y femenino, 91,4%. La etiología más frecuente fue la degenerativa con 45,8% y el lado mas afectado fue el izquierdo, 54,3%. Con un seguimiento promedio de 19 ± 8,6 meses, la evaluación funcional fue de 60 ± 12 puntos; en la evaluación radiológica se identificó que el 20,8% de los pacientes presentaron “riesgo” radiológico para aflojamiento protésico, mientras que sólo el 4,2% de ellos no tuvieron línea de radiolucencia. Hubo mejoría estadísticamente significativa del dolor postoperatorio con respecto al preoperatorio (p < 0,05); la satisfacción promedio fue del 72%; hubo un 8,3% de complicaciones. Conclusión En pacientes a los que aplicó hemiartroplastia de hombro, la funcionalidad del hombro operado se consideró como buena y la evaluación radiológica con resultado regular en pacientes con hemiartroplastia de hombro a medio plazo. Objective To determine the medium-term functional and radiological results in patients with hemiarthroplasty of the shoulder. Material and methods A descriptive cross-sectional study was performed in 25 patients with glenohumeral osteoarthritis of any etiology, age, sex and occupation who underwent hemiarthroplasty of the shoulder using a deltopectoral approach with placement of a cemented modular hemiprosthesis; between November 2000 and December 2002. Functional evaluation (Constant 0-100 points) and radiological assessment were performed to determine the “radiological risk” of prosthetic clinical loosening. Descriptive and inferential statistics for the study variables were performed. Results The prevalence of surgical disease was 0.4% of all first-time orthopedic consultations. The mean age was 61.7 ± 12.49 (range 32-85 years); men accounted for 8.6% and women for 91.4%. The most frequent etiology was degenerative (45.8%). The most frequently affected side was the left (54.3%). With a mean follow-up of 19 ± 8.6 months, functional evaluation was 60 ± 12 points; radiological evaluation showed that 20.8% of the patients presented “radiological risk” for prosthetic clinical loosening whereas only 4.2% showed no line of radiolucency. Postoperative pain was significantly lower than preoperative pain (p < 0.05); mean satisfaction was 72%. Complications occurred in 8.3%. Conclusion The functionality of the operated shoulder was good and radiological evaluation showed satisfactory medium-term results in patients with hemiarthroplasty of the shoulder. Palabras clave Hombro Hemiartroplastia Resultados Key words Shoulder Hemiarthroplasty Outcome Bibliografía 1. M.D. Chard B.L. Hazleman Shoulder disorders in the elderly Ann Rheum Dis 46 1987 684 687 2. M.L. Jenkinson M.R. Bliss A.T. Brain D.L. Scott Peripheral arthritis in the elderly Ann Rheum Dis 48 1989 227 231 3. D. Van Schaardenburg K.J.S. Van den Brande G.J. Ligthart Musculoskeletal disorders and disability in persons aged 85 and over Ann Rheum Dis 53 1994 807 811 4. C.A. Rockwood F.A. Matsen Hombro 2. a ed. 2000 McGraw-Hill Interamericana México 5. W.F. Bennett C. Gerber Operative treatment of the rheumatoid shoulder Curr Opin Rheumatol 6 1994 177 182 6. I.G. Kelly Surgery of the rheumatoid shoulder Ann Rheum Dis 49 1990 824 829 7. I.G. Kelly Shoulder arthroplasty in rheumatoid arthritis Clin Orthop 307 1994 94 102 8. J.A. Pahle L. Kvarnes Shoulder synovectomy Ann Chirurg Gynecol 75 1985 37 39 9. M.N. Smith-Peterson O.E. Aufranc Useful surgical procedures for rheumatoid arthritis involving joints of the upper extremity Arch Surg 46 1943 764 770 10. D.F. Craviotto D.G. Selzer M.A. Wirth Resection arthroplasty for salvage of failed shoulder arthroplasty. American Shoulder and Elbow Surgeons Annual Meeting New Orleans 1994 11. J.M. Mason The treatment of dislocation of shoulder-joint complicated by fracture of the upper extremity of the humerus Ann Surg 47 1998 672 12. A. Steindler Orthopedic operations 1994 Charles C. Thomas Springfield IL p. 302 13. R.H. Cofield Shoulder arthrodesis and resection arthroplasty Instru Course Lect 34 1985 268 277 14. R.H. Cofield B.T. Briggs Glenohumeral arthritis J Bone Joint Surg 61A 1979 668 677 15. C.A. Rockwood Jr R.N. Jarman Complications of shoulder arthrodesis using internal fixation Orthop Trans 15 1991 45 16. T. Lugli Artificial shoulder joint by Péan: the facts of an exceptional intervention and the prosthetic method Clin Orthop 133 1978 215 218 17. I.I. Neer CS T.H. Brown Jr H.L. McLaughlin Fracture of the neck of the humerus with dislocation of the head fragment Am J Surg 85 1953 252 258 18. C.S. Neer Articular replacement for the humeral head J Bone Joint Surg 37A 1955 215 228 19. C.S. Neer II Replacement arthroplasty for glenohumeral arthritis J Bone Joint Surg 56A 1974 1 13 20. Neer F.C.S. II D.S. Morrison Glenoid bone grafting in total shoulder arthroplasty J Bone Joint Surg 70A 1988 1154 1162 21. U. Rydholm J. Sjogren Surface replacement of the humeralhead in the rheumatoid shoulder J Shoulder Elbow Surg 2 1993 286 295 22. E. Cockx T. Claes M. Hoogmartens J.C. Mulier The isoelastic prosthesis for the shoulder joint Acta Orthop Belg 49 1983 275 285 23. W.N. Bodey P.M. Yeoman Prosthetic arthroplasty of the shoulder Acta Orthop Scand 54 1983 900 903 24. I.G. Kelly R.S. Foster Neer total shoulder replacement in rheumatoid arthritis J Bone Joint Surg 69B 1987 723 726 25. J. Zippel Luxationssichere Schulterendoprothese Modell BME Z Orthop 113 1975 454 457 26. R.H. Cofield Total shoulder arthroplasty with the Neer prosthesis J Bone Joint Surg Am 66 1984 899 906 27. M.E. Torchia R.H. Cofield C.R. Settergren Total shoulder arthroplasty with the Neer prothesis: long term results J Shoulder Elbow Surg 6 1997 495 505 28. S.W. O’Driscoll T.W. Wright R.H. Cofield D.M. Llstrup P. Mansat Problemes glenoidiens. Evaluation radiographique du composant glenoidien dans les protheses totales d’épaule. N.° 68 1999 Expansion Scientifique Publications Paris p. 337-44 29. J.W. Sperling R.H. Cofield S.W. O’Driscoll M.E. Torchia C.M. Rowland Radiographic assessment of ingrowth total shoulder arthroplasty J Shoulder Elbow Surg 9 2000 507 513 30. J. Sánchez-Sotelo S.W. O’Driscoll M.E. Torchia R.H. Cofield C.M. Rowland Radiographic assessment of cemented humeral components in shoulder arthroplasty J Shoulder Elbow Surg 10 2001 526 531 31. C.R. Constant A.H. Murley A clinical method of functional assessment of the shoulder Clin Orthop Rel Res 214 1987 160 164 32. F.A. Matsen J. Antoniou R. Rozencwaig Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease J Shoulder Elbow Surg 9 2000 465 469 33. J.D. Zuckerman J.S. Amaryllis M.A. Gallagher Hemiarthroplasty for cuff tear arthropathy J Shoulder Elbow Surg 9 2000 169 172 34. P. Boileau C. Trojani G. Walch R. Sinnerton Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus J Shoulder Elbow Surg 10 2001 299 308